Abstract: Objective To observe the short-term efficacy of concurrent IMRT hyperfraction radiochemotherapy combined with adjuvant chemotherapy on elderly patients with locally advanced esophageal cancer. Methods We retrospectively analyzed 52 elderly patients with locally advanced esophageal cancer. Thirty patients were grouped in observation group who were treated with concurrent hyperfraction IMRT (64.4-75.9Gy/56-66F, 1.15Gy/F, Bid, 5F/W) and concurrent chemotherapy Nedaplatin(25-30mg/m²/W), following 4-6 cycles of adjuvant chemotherapy with capecitabine(2 000-2 500mg/m²). Other 22 patients whose radiotherapy program was 52-60Gy/26-30F, 2Gy/F, Qd, 5F/W were divided into control group, and remaining treatment was same as observation group. Results In the observation group, the swallow obstruction of 28 patients were alleviated in one month after concurrent radiochemotherapy; the median survival time was 29 months; the 1-, 2- and 3-year survival rates were 87%, 66% and 25%, respectively. In the control group, the swallow obstruction of 16 patients were remitted; the median survival time was 26 months; the 1-, 2- and 3-year survival rates were 83%, 61% and 22%, respectively. The survival rate was not statistically different between two groups(P=0.19). Median survival time of progression-free survival were 25 and 20 months in observation group and control group (P=0.041). The adverse reactions between two groups were not statistically different. Conclusion Compared with routine fraction, concurrent hyperfraction radiochemotherapy combined with adjuvant capetabine chemotherapy help to remit early obstruction of elderly patients with locally advanced esophageal cancer and improve progression-free survival time without increasing adverse reaction.